- UNC Health Care (Raleigh, NC)
- …(EDD). Complete follow-up from CAPP as appropriate. As necessary meet with the Utilization Manager ( UM ) and SW after the meeting to discuss updates and action ... team on an ongoing basis. Identify required authorization for post-discharge services and refer to the appropriate post-discharge service provider.… more
- Stony Brook University (Stony Brook, NY)
- …examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services * + Complete electronic reference check with a minimum of three (3) ... RN Case Manager **Position Summary** At Stony Brook Medicine, a...a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will demonstrate… more
- Robert Half (Cincinnati, OH)
- JOB REQUISITION Talent Manager LOCATION CINCINNATI ADDITIONAL LOCATION(S) JOB DESCRIPTION You Belong Here The Protiviti Career provides opportunity to learn, ... We Need You We are looking for a Talent Manager to join our T alent M anagement team....Bachelor's degree in relevant discipline ( b usiness, h um anr esources, c ommunications, etc.) + 5 +… more
- Dartmouth Health (Lebanon, NH)
- Overview Care Manager , RN - Capacity Coordination Center 4 x 10 hour shifts Days, with every other Weekend As part of a multi-disciplinary team, applies nursing ... and post-acute care discharge coordination. Processes require review of the medical record, extensive collaboration with hospital providers, and transportation teams… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality ... professional clinical judgment to determine a member's appropriateness for case management services . + Initiates case management, as outlined in the Case Management… more
- Highmark Health (Baton Rouge, LA)
- …management strategies including: review of appropriateness of health care services , application of criteria to ensure appropriate resource utilization, ... of quality issues. Monitors and analyzes the delivery of health care services ; educates providers and members on a proactive basis; and analyzes qualitative… more
- Commonwealth Care Alliance (Boston, MA)
- …Operating Procedures * Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy * Works with ... ) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and... UM Manager and other clinical leadership to… more
- Rochester Regional Health (Rochester, NY)
- …and/or CMS guidelines. Responsibilities include managing the workflow with the standard UM sources for potential inpatient medical necessity denials. Assists and ... denial management as needed across the organization. RESPONSIBILITIES: + Review standard UM sources for potential inpatient medical necessity denials. Review… more
- Commonwealth Care Alliance (Boston, MA)
- …Operating Procedures + Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works with ... ) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and... UM Manager and other clinical leadership to… more
- University of Maryland, Baltimore (Baltimore, MD)
- …candidate will be expected to supervise and mentor staff and fellows within the UM -IHC, and may provide clinical service in their selected field. Qualified ... *The University of Maryland Institute for Health Computing ( UM -IHC) is recruiting for a tenure-track physician-scientist with...of Maryland College Park, and the University of Maryland Medical System, funded with initial grants from the State… more
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